Ralph DiClemente
Ralph DiClemente
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Professor of Social and Behavioral Sciences
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Professional overview
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Dr. Ralph DiClemente was trained as a Health Psychologist at the University of California, San Francisco where he received his PhD in 1984 after completing a ScM at the Harvard School of Public Health. He earned his undergraduate degree at the City University of New York.
Dr. DiClemente’s research has four key foci:
- Developing interventions to reduce the risk of HIV/STD among vulnerable populations
- Developing interventions to enhance vaccine uptake among high-risk adolescents and women, such as HPV and influenza vaccine
- Developing implementation science interventions to enhance the uptake, adoption and sustainability of HIV/STD prevention programs in the community
- Developing diabetes screening and behavior change interventions to identify people with diabetes who are unaware of their disease status as well as reduce the risk of diabetes among vulnerable populations.
He has focused on developing intervention packages that blend community and technology-based approaches that are designed to optimize program effectiveness and enhance programmatic sustainability.
Dr. DiClemente is the author of ten CDC-defined, evidence-based interventions for adolescents and young African-American women and men. He is the author of more than 540 peer-review publications, 150 book chapters, and 21 books. He serves as a member of the Office of AIDS Research Advisory Council.
Previously, Dr. DiClemente served as the Charles Howard Candler Professor of Public Health at the Rollins School of Public Health at Emory University. He was also Associate Director of the Center for AIDS Research, and was previously Chair of the Department of Behavioral Sciences and Health Education at the Rollins School of Public Health.
Dr. DiClemente is Past President of the Georgia chapter of the Society for Adolescent Health & Medicine. He previously served as a member of the CDC Board of Scientific Counselors, and the NIMH Advisory Council.
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Education
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BA, The City College of the City University of New York (CCNY), New York, NYScM, Behavioral Sciences, Harvard University, Cambridge, MAPhD, Health Psychology, University of California San Francisco Center for Behavioral Sciences, San Francisco, CAPostdoctoral Fellow, University of California, San Francisco, CA
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Areas of research and study
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Community InterventionsDiabetesHIV/AIDSImplementation scienceInfluenzaPsychology
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Publications
Publications
Childhood Violence, High School Academic Environment, and Adult Alcohol Use Among Latinas and Black Women: A Structural Equation Modeling Study
AbstractCapasso, A., Tozan, Y., DiClemente, R. J., & Pahl, K. (n.d.).Publication year
2024Journal title
Journal of Interpersonal ViolenceVolume
39Issue
23Page(s)
4924-4953AbstractObjective: Young Latinas and Black women drink less than women of other racial/ethnic groups but experience more alcohol-related problems in midlife. This study aims to identify modifiable factors to prevent adult onset of alcohol use disorder (AUD) in this population. Methods: Data were collected at six time points as part of the Harlem Longitudinal Development Study from 365 Latinas (47%) and Black (53%) women (mean age at time 1 = 14, standard deviation 1.3). Structural equation modeling was used to test hypothesized pathways from childhood physical and sexual abuse to AUD via depressive mood, anxiety disorders, and somatic complaints in the 20s. We also tested the moderation effect of the high school academic environment by including in the structural equation model two latent variable interaction terms between the school environment and each of the abuse variables. Results: Childhood physical and sexual abuse was positively associated with depressive mood, anxiety disorders, and somatic complaints when participants were in the 20s. Depressive mood mediated childhood abuse and AUD when women were in the 30s. The high school academic environment attenuated the effect of physical, but not sexual abuse, on depressive mood (β = −0.59, B = −9.38, 95% CI [−14.00, −4.76]), anxiety symptoms (β = −0.61, B = −14.19, 95% CI [−21.76, −6.61]), appetite loss (β = −0.41, B = −10.52, 95% CI [−15.61, −5.42]), and sleeplessness (β = −0.50, B = −9.56, 95% CI [−13.95, −5.17]) in the early 20s. Conclusions: Our findings underscore the need to invest in early violence prevention interventions and in education to ensure equitable access to quality, academically oriented, and safe schools.Comparing the Influences of Spouses or Partners With Other Family Members in the Ability of Young Asian Americans to Maintain a Healthy Lifestyle
AbstractKwon, S., Ali, S. H., & DiClemente, R. J. (n.d.).Publication year
2024Journal title
American Journal of Lifestyle MedicineAbstractThe relationship between family dynamics and health has been extensively studied, but the specific pathways involved are not yet fully understood. The role of intimate partner relationships in promoting and maintaining healthy lifestyle behaviors remains understudied, particularly in minority populations. This study addressed this gap by examining how frequent spousal and familial interactions affect healthy lifestyle behaviors in young Asian Americans. Survey data from Asian American adults aged 18 to 35, collected in March 2021, is used to compare two groups: one interacting most with an intimate partner and the other interacting most with other non-intimate family members. The results showed that young Asian Americans interact most with their spouses/partners and mothers. Participants who interacted most frequently with their spouses/partners reported a greater influence in maintaining a healthy lifestyle, particularly in the domains of exercise and sleep. Moreover, those who interacted more with their spouses/partners exhibited a greater sense of connectedness, which impacted spousal and personal influence on healthy lifestyle behaviors. The findings suggest that promoting interaction and fostering stronger spousal/partner relationships can positively influence the healthy lifestyle behaviors of young Asian Americans.Determinants of an HIV Preventive Vaccine among a Highly Vulnerable Population: African American Men Who Have Sex with Men
AbstractXu, M. A., Choi, J., Rosenberger, J. G., Zimmerman, R. S., & DiClemente, R. (n.d.).Publication year
2024Journal title
VaccinesVolume
12Issue
3AbstractAfrican American men who have sex with men (MSM) are disproportionately impacted by HIV and may benefit from the development of an HIV vaccine. African American MSM are adversely affected by discrimination as a function of both their race and sexual behaviors. This may further increase the challenges associated with persuading them to adopt an HIV vaccine. Developing a knowledge base characterizing African American MSM HIV vaccine perceptions, attitudes, and concerns may help strengthen how healthcare providers and other health stakeholders describe and discuss the advent of an HIV vaccine. This study assessed the knowledge, attitudes, beliefs, and intentions related to HIV vaccination among African American MSM. This study comprised 432 African American MSM, 18–64 years, residing in the United States. Vaccine intention was defined as how likely it is that an individual would adopt an HIV vaccine if a vaccine was available and it was 90% effective against HIV, easy to obtain, free, and had few side effects. Relative to African American MSM who intend to delay receiving an HIV vaccination, controlling for age, education, and income, early vaccine adopters who had received ≥ 2 COVID-19 vaccinations and who had high WHO HIV Vaccine Positive Attitude Scale scores were, respectively, 3.2 times and 2.4 times more likely to report the intention to vaccinate within one year. Early vaccine adopters were also 2.4 times more likely to feel that HIV prevention support discriminates against African American MSM. Those reporting three or more sexual partners and medical mistrust were, respectively, 60% and 59% more likely to report the intention to delay HIV vaccination. The lack of a knowledge base on HIV vaccine perceptions and acceptability is a missed opportunity to provide guidance on how stakeholders, such as health providers and policymakers, should address HIV vaccine hesitancy once this crucial vaccine is licensed. The key factors affecting vaccine adoption are valuable in developing and implementing campaigns to enhance the HIV vaccine coverage in this vulnerable population.Ensuring fidelity: key elements to consider in disseminating a diabetes telemanagement program for underserved Hispanic/Latinos living with type 2 diabetes
AbstractMartinez, S., Nouryan, C. N., Williams, M. S., Patel, V. H., Barbero, P., Correa Gomez, V., Marino, J., Goris, N., Cigaran, E., Granville, D., Murray, L. F., Harris, Y. T., Myers, A., Guzman, J., Makaryus, A. N., McFarlane, S. I., Zeltser, R., Pena, M., Sison, C., … Pekmezaris, R. (n.d.).Publication year
2024Journal title
Frontiers in Clinical Diabetes and HealthcareVolume
5AbstractBackground: The Hispanic/Latino population has greater risk (estimated >50%) of developing type 2 diabetes (T2D) and developing it at a younger age. The American Diabetes Association estimates costs of diagnosed diabetes in 2017 was $327 billion; with medical costs 2.3x higher than patients without diabetes. The purpose of this manuscript is to describe the methodology utilized in a randomized controlled trial aimed at evaluating the efficacy of a diabetes telemanagement (DTM) program for Hispanic/Latino patients with T2D. The intent is to provide information for future investigators to ensure that this study can be accurately replicated. Methods: This study was a randomized controlled trial with 240 participants. Eligible patients (Hispanic/Latino, aged 18+, living with T2D) were randomized to Comprehensive Outpatient Management (COM) or DTM. DTM was comprised of usual care, including routine clinic visits every three months, as well as: Biometrics (a tablet, blood glucose meter, blood pressure monitor, and scale); Weekly Video Visits (facilitated in the patient’s preferred language); and Educational Videos (including culturally congruent diabetes self-management education and quizzes). COM consisted of usual care including routine clinic visits every three months. For this study, COM patients received a glucometer, glucose test strips, and lancets. Establishing a therapeutic nurse-patient relationship was a fundamental component of our study for both groups. First contact (post-enrollment) centered on ensuring that patients and caregivers understood the program, building trust and rapport, creating a non-judgmental environment, determining language preference, and establishing scheduling availability (including evenings and weekends). DTM were provided with a tablet which allowed for self-paced education through videos and weekly video visits. The research team and Community Advisory Board identified appropriate educational video content, which was incorporated in diabetes educational topics. Video visits allowed us to assess patient involvement, motivation, and nonverbal communication. Communicating in Spanish, and awareness of diverse Hispanic/Latino backgrounds was critical, as using relevant and commonly-used terms can increase adherence and improve outcomes. Shared decision-making was encouraged to make realistic health care choices. Conclusion: Key elements discussed above provide a framework for future dissemination of an evidence-based DTM intervention to meet the needs of underserved Hispanic/Latino people living with T2D.Exploring sleep difficulties, alcohol, illicit drugs, and suicidal ideation among adolescents with a history of depression
AbstractRobbins, R., Weaver, M. D., Quan, S. F., Logan, R. W., Czeisler, C. A., & DiClemente, R. J. (n.d.).Publication year
2024Journal title
Psychiatry ResearchVolume
340AbstractSleep difficulties and misuse of drugs/alcohol have been associated with suicidal ideation in young people. Using cross-sectional representative surveys of adolescents in the United States, we conducted adjusted logistic regression modeling to assess the relationships between sleep difficulties, substance use, and suicidal ideation among adolescents with a history of depression (n = 38,418) between 2015 and 2020. Sleep difficulties were associated with thinking about (aOR=1.6,95%CI:1.3–1.9), planning (aOR=1.8,95%CI:1.2–2.6), or attempting (aOR=1.7,95%CI:1.2–2.5) suicide. In those reporting alcohol abuse/dependence, sleep difficulties were associated with attempting suicide (aOR=3.1,95%CI:1.2–8.5). In those reporting illicit drug abuse/dependence, sleep difficulties were associated with thinking about (aOR=2.1,95%CI:1.1–4.1) and attempting (aOR=2.2,95%CI:1.2–4.1) suicide.How Shared Dietary Behaviors Within Asian American Families Are Influenced by Emotional Interaction Qualities: A Nationwide Cross-sectional Analysis
AbstractAli, S. H., Meltzer, G., DiClemente, R. J., Islam, N. S., Yi, S. S., Yang, L. H., & Misra, S. (n.d.).Publication year
2024Journal title
International Journal of Behavioral MedicineAbstractBackground: Asian American (AA) young adults face a looming diet-related non-communicable disease crisis. Interactions with family members are pivotal in the lives of AA young adults and form the basis of family-based interventions; however, little is known on the role of these interactions in shared family food behaviors. Through an analysis of 2021 nationwide survey data of 18–35-year-old AAs, this study examines how the quality of family member interactions associates with changes in shared food purchasing, preparation, and consumption. Method: Interaction quality was assessed through 41 emotions experienced while interacting with family, and was categorized as positive (e.g., “I look forward to it”), negative (e.g., “I feel annoyed”), and appreciation-related (e.g., “I feel respected”) interactions. Participants were also asked how frequently they ate meals, ate out, grocery shopped, and cooked with their family. Results: Among the 535 AAs surveyed (47.6% East Asian, 21.4% South Asian, 22.6% Southeast Asian), 842 unique family interactions were analyzed; 43.5% of interactions were with mothers, followed by siblings (27.1%), and fathers (18.5%). Participants most frequently ate meals with their family (at least daily for 33.5% of participants), followed by cooking (at least daily for 11.3%). In adjusted analyses, an increase in shared food behaviors was particularly associated with positive interactions, although most strongly with cooking together and least strongly with eating meals together; significant differences between ethnic subgroups were not observed. Conclusion: Findings revealed the importance of family interaction quality when leveraging family relationships to develop more tailored, impactful AA young adult dietary interventions.Mutual capacity building model for adaptation (MCB-MA): a seven-step procedure bidirectional learning and support during intervention adaptation
AbstractJack, H. E., Giusto, A., Rose, A. L., Mwamuka, R., Brown, I., Bere, T., Verhey, R., Wainberg, M., Myers, B., Kohrt, B., Wingood, G., DiClemente, R., & Magidson, J. F. (n.d.).Publication year
2024Journal title
Global Health Research and PolicyVolume
9Issue
1AbstractGlobal health reciprocal innovation emphasizes the movement of technologies or interventions between high- and low-income countries to address a shared public health problem, in contrast to unidirectional models of “development aid” or “reverse innovation”. Evidence-based interventions are frequently adapted from the setting in which they were developed and applied in a new setting, presenting an opportunity for learning and partnership across high- and low-income contexts. However, few clear procedures exist to guide researchers and implementers on how to incorporate equitable and learning-oriented approaches into intervention adaptation across settings. We integrated theories from pedagogy, implementation science, and public health with examples from experience adapting behavioral health interventions across diverse settings to develop a procedure for a bidirectional, equitable process of intervention adaptation across high- and low-income contexts. The Mutual capacity building model for adaptation (MCB-MA) is made up of seven steps: 1) Exploring: A dialogue about the scope of the proposed adaptation and situational appraisal in the new setting; 2) Developing a shared vision: Agreeing on common goals for the adaptation; 3) Formalizing: Developing agreements around resource and data sharing; 4) Sharing complementary expertise: Group originating the intervention supporting the adapting group to learn about the intervention and develop adaptations, while gleaning new strategies for intervention implementation from the adapting group; 5) Reciprocal training: Originating and adapting groups collaborate to train the individuals who will be implementing the adapted intervention; 6) Mutual feedback: Originating and adapting groups share data and feedback on the outcomes of the adapted intervention and lessons learned; and 7) Consideration of next steps: Discuss future collaborations. This evidence-informed procedure may provide researchers with specific actions to approach the often ambiguous and challenging task of equitable partnership building. These steps can be used alongside existing intervention adaptation models, which guide the adaptation of the intervention itself.Pivoting from in-person to phone survey assessment of alcohol and substance use: effects on representativeness in a United States prospective cohort of women living with and without HIV
AbstractTierney, H. R., Ma, Y., Bacchetti, P., Adimora, A. A., Chandran, A., Kempf, M. C., Collins, L. F., DeHovitz, J., DiClemente, R. J., French, A. L., Jones, D. L., Sharma, A., Spence, A. B., Hahn, J. A., Price, J. C., & Tien, P. C. (n.d.).Publication year
2024Journal title
American Journal of Drug and Alcohol AbuseVolume
50Issue
1Page(s)
54-63AbstractBackground: Many clinical and population-based research studies pivoted from in-person assessments to phone-based surveys due to the COVID-19 pandemic. The impact of these transitions on survey response remains understudied, especially for people living with HIV. Given that there are gender-specific trends in alcohol and substance use, it is particularly important to capture these data for women. Objective: Identify factors associated with responding to an alcohol and substance use phone survey administered during the COVID-19 pandemic in the Women’s Interagency HIV Study, a multicenter US prospective cohort of women living with and without HIV. Methods: We used multivariable logistic regression to assess for associations of pre-pandemic (April–September 2019) sociodemographic factors, HIV status, housing status, depressive symptoms, alcohol use, and substance use with response to an early-pandemic (August–September 2020) phone survey. Results: Of 1,847 women who attended an in-person visit in 2019, 78% responded to a phone survey during the pandemic. The odds of responding were lower for women of Hispanic ethnicity (aOR 0.47 95% CI 0.33–0.66, ref=Black/African American) and those who reported substance use (aOR 0.63 95% CI 0.41–0.98). By contrast, the odds were higher for White women (aOR 1.64 95% CI 1.02–2.70, ref=Black/African American) and those with stable housing (aOR 1.74 95% CI 1.24–2.43). Conclusions: Pivoting from an in-person to phone-administered alcohol and substance use survey may lead to underrepresentation of key subpopulations of women who are often neglected in substance use and HIV research. As remote survey methods become more common, investigators need to ensure that the study population is representative of the target population.Reach and Capacity of Black Protestant Health Ministries as Sites of Community-Wide Health Promotion: A Qualitative Social Ecological Model Examination
AbstractFuller, T. J., Lambert, D. N., DiClemente, R. J., & Wingood, G. M. (n.d.).Publication year
2024Journal title
Journal of Racial and Ethnic Health DisparitiesAbstractBlack communities in the Southeast United States experience a disproportionate burden of illness and disease. To address this inequity, public health practitioners are partnering with Black Protestant churches to deliver health promotion interventions. Yet, the reach of these programs beyond the organizational level of the Social Ecological Model (SEM) is not well defined. Thus, the aim of this study is to understand Black Protestant church leaders’ and members’ perceptions about the capacity of their ministries to reach into their communities, beyond their congregations, as providers or hosts of health education or promotion interventions. From 20 Black Protestant churches in Atlanta, GA, 92 church leaders and members participated in semi-structured interviews. Grounded theory guided data analysis and a diverse team coded the interviews. Most participating churches had health ministries. Participants saw the boundaries between their churches at the organizational level of the SEM and the broader Black community to be porous. Those who described their “community” as being broader than their congregation also tended to describe community-wide health promotion their church engaged in. They described church-based health fairs as a strategy to promote engagement in their communities. Some participants, particularly those in a health-related profession, discussed visions of how to utilize their church as a site for community-wide health promotion. We suggest these participants may be boundary leaders who can build relationships between public health professionals, pastors, and congregants. Based on the findings, we suggest that church-based health fairs may be effective sites of community-wide health promotion.‘We know what he likes, even if he doesn’t know’: how the children of South Asian immigrants characterize and influence the diets of their parents
AbstractAuer, S., Penikalapati, R., Parekh, N., Merdjanoff, A. A., DiClemente, R. J., & Ali, S. H. (n.d.).Publication year
2024Journal title
Health Education ResearchVolume
39Issue
2Page(s)
131-142AbstractForeign-born (first-generation) South Asians face a growing diet-related chronic disease burden. Little is known about whether the adult US-born (second-generation) children of South Asian immigrants can provide unique insights as changemakers in their parents’ dietary behaviors. This study aims to assess how second-generation South Asians describe and influence the dietary behaviors of their parents. Between October and November 2020, 32 second-generation South Asians [mean age 22.4 (SD 2.9), 53% female] participated in online interviews centered around factors involved in their (and their parents) eating behaviors. Thematic analysis revealed three types of parental dietary drivers (socioecological factors that impact the dietary choices of parents): goal-oriented (i.e., parents’ dietary intentionality), capacity-related (e.g., environmental barriers) and sociocultural (cultural familiarity, religion and traditions). Participants described three major mechanisms of influence: recommending new foods, cooking for parents, and bringing new foods home. These influences primarily occurred in the household and often involved participants leveraging their own nutritional knowledge and preferences to expand dietary diversity and healthier behaviors among their parents. Evidence suggests that second-generation South Asians may act as powerful agents of dietary change within their households and can provide novel insights to help address and overcome sociocultural, linguistic, and other structural barriers to better understanding and intervening in the health of the South Asian community.A Multi-Stage Dyadic Qualitative Analysis to Disentangle How Dietary Behaviors of Asian American Young Adults are Influenced by Family
AbstractAli, S. H., Cai, J., Kamal, F., Auer, S., Yang, K., Parikh, R. S., Parekh, N., Islam, N. S., Merdjanoff, A. A., & DiClemente, R. J. (n.d.).Publication year
2023Journal title
Behavioral MedicineAbstractThe dietary behaviors of Asian American (AA) young adults, who face a growing non-communicable disease burden, are impacted by complex socio-ecological forces. Family plays a crucial role in the lifestyle behaviors of AA young adults; however, little is known on the methods, contributors, and impact of familial dietary influence. This study aims to deconstruct the mechanisms of AA young adult familial dietary influence through a multi-perspective qualitative assessment. A five-phase method of dyadic analysis adapted from past research was employed to extract nuanced insights from dyadic interviews with AA young adults and family members, and ground findings in behavioral theory (the Social Cognitive Theory, SCT). 37 interviews were conducted: 18 young adults, comprising 10 different AA ethnic subgroups, and 19 family members (10 parents, 9 siblings). Participants described dietary influences that were both active (facilitating, shaping, and restricting) and passive (e.g., sharing foods or environment, mirroring food behaviors). Influences connected strongly with multiple SCT constructs (e.g., behavioral capacity, reinforcements for active influences, and expectations, observational learning for passive influences). Familial influence contributed to changes in the total amount, variety, and healthfulness of foods consumed. Intra-family dynamics were crucial; family members often leveraged each other’s persuasiveness or food skills to collaboratively influence diet. AA family-based interventions should consider incorporating both passive and active forms of dietary influence within a family unit, involve multiple family members, and allow for individualization to the unique dynamics and dietary behaviors within each family unit.Concordance of Ethyl Glucuronide, Blood Alcohol Content, and Self-Reported Alcohol Use in Russian Women with HIV and Hepatitis C Virus Co-Infection
AbstractBrown, J. L., Capasso, A., Revzina, N., Boeva, E., Rassokhin, V., Sales, J. M., Gutova, L. V., Khalezova, N. B., Hitch, A. E., Twitty, T. D., & DiClemente, R. J. (n.d.).Publication year
2023Journal title
AIDS and BehaviorVolume
27Issue
12Page(s)
4062-4069AbstractProblematic alcohol use is prevalent in Russia and is deleterious for individuals with HIV and Hepatitis C Virus (HCV). Ethyl glucuronide (EtG) and blood alcohol content (BAC) provide objective biomarkers of drinking that can be compared to self-reported alcohol use. This paper describes patterns of alcohol use measured by biomarkers and self-report along with concordance across measures. Participants were Russian women with HIV and HCV co-infection (N = 200; Mean age = 34.9) from two Saint Petersburg comprehensive HIV care centers enrolled in an alcohol reduction intervention clinical trial. Measures were: (a) urine specimen analyzed for EtG; (b) breathalyzer reading of BAC; and (c) self-reported frequency of drinking, typical number of drinks consumed, and number of standard drinks consumed in the past month. At baseline, 64.0% (n = 128) had a positive EtG (> 500 ng/mL) and 76.5% (n = 153) had a positive breathalyzer reading (non-zero reading). There was agreement between EtG and BAC (kappa = 0.66, p <.001; Phi coefficient = 0.69, p <.001); self-reported alcohol measures were positively correlated with positive EtG and BAC (p’s < 0.001). There was concordance between EtG and BAC measures, which have differing alcohol detection windows. Most participants endorsed frequent drinking at high quantities, with very few reporting no alcohol consumption in the past month. Concordance between biomarkers and self-reported alcohol use suggests that underreporting of alcohol use was minimal. Results highlight the need for alcohol screening within HIV care. Implications for alcohol assessment within research and clinical contexts are discussed.COVID-19 stressors for Hispanic/Latino patients living with type 2 diabetes: a qualitative study
AbstractWilliams, M. S., Cigaran, E., Martinez, S., Marino, J., Barbero, P., Myers, A. K., DiClemente, R. J., Goris, N., Gomez, V. C., Granville, D., Guzman, J., Harris, Y. T., Kline, M., Lesser, M. L., Makaryus, A. N., Murray, L. M., McFarlane, S. I., Patel, V. H., Polo, J., … Pekmezaris, R. (n.d.).Publication year
2023Journal title
Frontiers in Clinical Diabetes and HealthcareVolume
4AbstractBackground and aim: During the early stages of the COVID-19 pandemic, nationwide lockdowns caused disruption in the diets, physical activities, and lifestyles of patients with type 2 diabetes. Previous reports on the possible association between race/ethnicity, COVID-19, and mortality have shown that Hispanic/Latino patients with type 2 diabetes who are socioeconomically disadvantaged are disproportionately affected by this novel virus. The aim of this study was to explore stressors associated with changes in diabetes self-management behaviors. Our goal was to highlight the health disparities in these vulnerable racial/ethnic minority communities and underscore the need for effective interventions. Methods and participants: Participants were enrolled in part of a larger randomized controlled trial to compare diabetes telehealth management (DTM) with comprehensive outpatient management (COM) in terms of critical patient-centered outcomes among Hispanic/Latino patients with type 2 diabetes. We conducted a thematic analysis using patient notes collected from two research nurses between March 2020 and March 2021. Two authors read through the transcripts independently to identify overarching themes. Once the themes had been identified, both authors convened to compare themes and ensure that similar themes were identified within the transcripts. Any discrepancies were discussed by the larger study team until a consensus was reached. Results: Six themes emerged, each of which can be categorized as either a source or an outcome of stress. Sources of stress associated with the COVID-19 pandemic were (1) fear of contracting COVID-19, (2) disruptions from lockdowns, and (3) financial stressors (e.g., loss of income). Outcomes of COVID-19 stressors were (1) reduced diabetes management (e.g., reduced diabetes monitoring and physical activity), (2) suboptimal mental health outcomes (e.g., anxiety and depression), and (3) outcomes of financial stressors. Conclusion: The findings indicated that underserved Hispanic/Latino patients with type 2 diabetes encountered a number of stressors that led to the deterioration of diabetes self-management behaviors during the pandemic.Crush: A Randomized Trial to Evaluate the Impact of a Mobile Health App on Adolescent Sexual Health
AbstractMartínez-García, G., Ewing, A. C., Olugbade, Y., DiClemente, R. J., & Kourtis, A. P. (n.d.).Publication year
2023Journal title
Journal of Adolescent HealthVolume
72Issue
2Page(s)
287-294AbstractPurpose: Mobile technology allows delivery of sexual and reproductive health (SRH) information directly to youth. We tested the efficacy of Crush, a mobile application aimed at improving sexual health by promoting the use of SRH services and contraception among female adolescents. Methods: We recruited 1,210 women aged 14–18 years through social media advertising and randomized them into a Crush intervention group and a control group that received a wellness app. At 3 and 6 months post randomization, we compared changes from baseline in behaviors, attitudes, self-efficacy, perceived social norms, birth control knowledge, perceived control and use intentions, and SRH service utilization. Odds ratios were estimated with multivariable logistic regression and adjusted for baseline outcome, age, race/ethnicity, mother's education, and sexual experience. Results: There was no difference in accessing SRH services according to study group. Three months post baseline, Crush users had higher odds (p < .05) than control participants of reporting confidence in accessing SRH services (adjusted odds ratio [aOR] = 1.6, 95% confidence interval [CI]: 1.1–2.3) and of believing that it is a good thing to use birth control consistently (aOR = 2.3, 95% CI: 1.4–3.8). Six months after baseline, Crush users had higher odds than control participants of reporting they can control whether birth control is used every time they have sex (aOR = 1.8, 95% CI: 1.2–2.6) and perceiving they would get pregnant if they did not use birth control (aOR: 1.5, 95% CI: 1.1–2.2). Impacts on other behavioral constructs were also found. Discussion: Crush was associated with improvements in knowledge, attitudes, and self-efficacy related to key SRH behaviors and may be a strategy to deliver SRH education to adolescent women. Studies including larger numbers of sexually active adolescents are needed to demonstrate behavioral impacts.Digital Communications Technology Use and Feelings of Anxiety, Depression, and Loneliness Among Older Adults During the COVID-19 Pandemic
AbstractRobbins, R., DiClemente, R. J., Baig, N., Johnson, A., Chou, A., & Van Den Bulck, J. (n.d.).Publication year
2023Journal title
Journal of Applied GerontologyVolume
42Issue
9Page(s)
1911-1920AbstractSome have touted technology as a panacea for overcoming the isolation associated with COVID-19 mitigation policies; yet, these tools are not widely adopted by older adults. With data from the COVID-19 supplement to the National Health and Aging Trends Survey, we conduct adjusted Poisson regression modeling to examine digital communications use during COVID-19 and feelings of anxiety, depression, and loneliness during the COVID-19 pandemic among older adults (65+ years of age). Adjusted Poisson regression revealed that those who reported frequent use of video calls with friends and family (aPR = 1.22, 95% CI:1.06–1.41) and with healthcare providers (aPR = 1.22, 95% CI:1.03–1.45) were more likely to report feelings of anxiety than those not using these platforms; yet, reports of in-person visits with friends and family (aPR = 0.79, 95% CI: 0.66–0.93) and with healthcare providers (aPR = 0.88, 95% CI: 0.77–1.01) were associated with fewer feelings of depression and loneliness, respectively. Future research is needed to tailor digital technology to support older adults.Do parental protective factors matter? Predicting HIV/STI risk among a sample of justice-involved African-American girls
AbstractCrooks, N., Sun, S., Wise, A., DiClemente, R., & Sales, J. M. D. (n.d.).Publication year
2023Journal title
Children and Youth Services ReviewVolume
149AbstractAfrican American adolescent girls are overrepresented in the juvenile justice system and are disproportionately affected by human immunodeficiency virus (HIV) and sexually transmitted infections (STI). Parental protection may play a critical role in the sexual behaviors of African American adolescent girls and help to inform family-based interventions. The current study investigated the impact of parental protective factors (monitoring, sex communication, and authoritarian parenting) on sexual risk-related outcomes in a sample (n = 172) of justice-involved, urban African American adolescent girls aged 13–17 years. Multiple linear regression analyses were conducted to estimate the association between parental protective factors and percentage of consistent condom use, HIV/STI knowledge, fear of condom negation, and condom self-efficacy 3 months after their release from detention centers. Baseline parental protective factors were significantly associated with sexual risk-related outcomes of African American adolescent girls. Parental monitoring was positively associated with consistency of condom use and increased HIV/STI knowledge. Parental communication about sex reduced fear of condom negotiation and increased condom self-efficacy. Authoritarian parenting predicted increased HIV/STI knowledge and fear of condom negotiation following release. Programs, policies, and interventions addressing the sexual health of African American adolescent girls should engage families to enhance protective factors to reduce their sexual risk.Evaluating the healthfulness of Asian American young adult dietary behaviors and its association with family structure: Disaggregated results from NHIS 2015
AbstractAli, S. H., Parekh, N., Islam, N. S., Merdjanoff, A. A., & DiClemente, R. J. (n.d.).Publication year
2023Journal title
Nutrition and HealthAbstractBackground: Asian Americans (AA) young adults face a growing non-communicable disease burden linked with poor dietary behaviors. Family plays a significant role in shaping the diet of AA young adults, although little is known on the specific types of family structures most associated with different dietary behaviors. Aim: This analysis explores the changes in dietary behaviors across different AA young adult family structural characteristics. Methods: Nationwide data of 18–35-year-old self-identified Asians surveyed in the 2015 National Health Interview Survey (NHIS) was analyzed. Family structure was measured through family size, family health, and family members in one's life. The Dietary Screener Questionnaire (DSQ) measured the average intake of 10 food and nutrient groups. Published dietary guidelines were used to calculate the number of dietary recommendations met. Results: 670 AA young adults with dietary data were analyzed (26.1% Asian Indian, 26.1% Chinese, 19.3% Filipino, 28.5% other Asian). Participants had an average family size of 2.3. In weighted analyses, 19% of AA young adults met none of the examined dietary recommendations, and only 14% met 3–4 guidelines. Living with a child was associated meeting more dietary recommendations (adjusted odds ratio [AOR]: 1.22; 95%CI: 1.05, 1.42). The adjusted association between living with an older adult and lower odds of meeting dietary recommendations approached significance (AOR: 0.70; 95%CI: 0.49, 1.00). Conclusions: Findings revealed the important role of children and older adults in influencing the diet of AA young adults. Further mixed-methods research to disentangle mechanisms behind the influence of family structure on diet is warranted.Examining Changes in Sleep Duration Associated with the Onset of the COVID-19 Pandemic: Who is Sleeping and Who is Not?
AbstractBatool-Anwar, S., Robbins, R., Ali, S. H., Capasso, A., Foreman, J., Jones, A. M., Tozan, Y., DiClemente, R. J., & Quan, S. F. (n.d.).Publication year
2023Journal title
Behavioral MedicineVolume
49Issue
2Page(s)
162-171AbstractThe COVID-19 pandemic has resulted in social isolation and reports of insomnia. However, reports of changes in sleep duration and associated factors are few. To determine the impact of COVID-19 on changes in sleep behavior, data were analyzed from an online survey of adults recruited via social media that included questions asking whether the respondent slept less or more after the onset of the pandemic as well as self-reported sociodemographic and occupational information; beliefs about COVID-19; and responses pertaining to loneliness, anxiety, and depression. There were 5,175 respondents; 53.9% had a change in sleep duration.17.1% slept less and 36.7% slept more. Sleeping more was related to greater education, being single/divorced/separated, unemployed or a student. Being retired, divorced/separated or a homemaker, and living in the Mountain or Central time zones were associated with less sleep. Beliefs that COVID-19 would result in personal adverse consequences was associated with both more and less sleep. However, the strongest associations for both more and less sleep were seen with depression, anxiety, and loneliness. In summary, changes in sleep duration since the start of the COVID-19 pandemic were highly prevalent among social media users and were associated with several sociodemographic factors and beliefs that COVID-19 would have adverse personal impacts. However, the strongest associations occurred with worse mental health suggesting that improvements may occur with better sleep. Supplemental data for this article is available online at https://doi.org/10.1080/08964289.2021.2002800.Exploring substance misuse behaviors among black girls in detention: Intersections of trauma, sex, and age
AbstractQuinn, C. R., Boyd, D. T., Menon, S. E., Mitchell, M., Radney, A., Coker, E. J., Lloyd Allen, J., Simmons-Horton, S., Hughley, A., DiClemente, R. J., & Voisin, D. R. (n.d.).Publication year
2023Journal title
Addictive BehaviorsVolume
143AbstractHigh risk substance misuse, trauma and gang involvement are prevalent in adolescents and often occur with youth involved with the youth punishment system. Evidence suggests that system involvement is related to trauma histories, substance misuse, as well as gang involvement. This study investigated the associations between individual and peer factors and their relationship to problem drug and alcohol use among Black girls involved with the youth punishment system. Data were collected from 188 Black girls in detention at baseline, as well as 3 and 6 month follow up periods. Measures assessed were abuse history, trauma history, sex while using drugs and alcohol, age, government assistance, and drug use. Significant findings from the multiple regression analyses indicated that younger girls were more likely to have a higher prevalence of having a drug problem than older girls at baseline. Having sex while on drugs and alcohol at the 3 month follow up period was correlated with drug use. These findings highlight how individual and peer factors can influence problem substance misuse, their behavior and peer relationships among Black girls in detention.Family connectedness and sexual minority Asian Americans' eating behavior regulation
AbstractLe, T. P., Ali, S. H., Atkin, A. L., Ching, T. H., Csizmadia, A., Tran, N. K., & DiClemente, R. J. (n.d.).Publication year
2023Journal title
Eating BehaviorsVolume
51AbstractTo date, psychosocial and interpersonal protective factors such as family connectedness have received little attention in studies of eating behaviors among sexual minority Asian Americans. Therefore, we investigated associations of family connectedness and two types of eating behavior regulation motives and the moderating role of individualism in these associations among 134 sexual minority Asian American young adults. Linear regression models assessed the main and interaction effects of family connectedness and individualism on introjected and identified eating behavior regulation motives. We observed a significant interaction effect between family connectedness and individualism only on introjected regulation. For participants with low levels of individualism, those who reported high levels of family connectedness had lower scores for introjected regulation of eating behavior. The findings of this study highlight the importance of examining strengths related to sexual minority Asian Americans by demonstrating the important role family connectedness plays in eating behavior regulation motives, particularly for those with lower individualism.Family Involvement in Asian American Health Interventions: A Scoping Review and Conceptual Model
AbstractAli, S. H., Mohsin, F. M., Rouf, R., Parekh, R., Dhar, B., Kaur, G., Parekh, N., Islam, N. S., & DiClemente, R. J. (n.d.).Publication year
2023Journal title
Public Health ReportsVolume
138Issue
6Page(s)
885-895AbstractFamily members play a crucial role in the health of Asian American communities, and their involvement in health interventions can be pivotal in optimizing impact and implementation. To explore how family members can be effectively involved in Asian American health interventions and develop a conceptual framework of methods of involvement at the stages of intervention development, process, and evaluation, this scoping review documented the role of Asian American family members in interventions (across any health objective). Of the 7175 studies identified through database and manual searches, we included 48 studies in the final analysis. Many studies focused on Chinese (54%) or Vietnamese (21%) populations, were conducted in California (44%), and involved spouses (35%) or parents/children (39%). We observed involvement across 3 stages: (1) intervention development (formative research, review process, material development), (2) intervention process (recruitment, receiving the intervention together, receiving a parallel intervention, enlisting support to achieve goals, voluntary intervention support, agent of family-wide change, and participation gatekeepers), and (3) intervention evaluation (received evaluation together, indirect impact evaluation, and feedback during intervention). Impact of family member involvement was both positive (as sources of encouragement, insight, accountability, comfort, and passion) and negative (sources of hindrance, backlash, stigma, obligation, and negative influence). Suggestions for future research interventions include (1) exploring family involvement in South Asian or young adult interventions, (2) diversifying types of family members involved (eg, extended family), and (3) diversifying methods of involvement (eg, family members as implementation agents).Internet-Delivered Sexually Transmitted Infection and Teen Pregnancy Prevention Program: A Randomized Trial
AbstractKissinger, P. J., Green, J., Latimer, J., Schmidt, N., Ratnayake, A., Madkour, A. S., Clum, G., Wingood, G. M., Diclemente, R. J., & Johnson, C. (n.d.).Publication year
2023Journal title
Sexually Transmitted DiseasesVolume
50Issue
6Page(s)
329-335AbstractBackground Black older-teenaged women have disproportionately high rates of sexually transmitted infections (STI) and unintended pregnancy (UTP). Internet-based interventions can be delivered to large groups of people in a relatively inexpensive manner. In this randomized trial, we examine the efficacy of an evidence-based STI/UTP prevention intervention adapted for older teens and for Internet delivery. Methods Black women aged 18-19 years who were not pregnant/seeking to become pregnant were enrolled (n = 637) and randomized to an 8-session intervention or attention control and were followed up at 6/12 months postintervention. The primary outcome was defined as uptake of reliable contraceptives. Other secondary outcomes were examined, including intention to use condoms, intention to use reliable contraception, and STI or pregnancy rates. Results Overall, at baseline, reliable contraception was 54.8% and dual protection was 29.4%, and the prevalence of STI was 11.1%. Participants were similar by arm for most factors considered. Participation and follow-up rates were excellent (60.9% and 80.3%). There was no statistically significant difference in uptake of reliable contraception for intervention versus controls at 6 months (1.45 [0.99-2.12]) or 12 months (1.33 [0.92-1.91]). At 6 months, several secondary outcomes were improved/trended toward improvement in intervention compared with control, but this effect waned by 12 months, except for intention to use condoms which remained improved. Conclusion and Relevance The intervention was efficacious for increasing some self-reported UTP and STI prevention behaviors, which waned over time, and the intervention had minimal impact on STI or pregnancy rates suggesting that this type of online intervention may need additional components.Interpersonal abuse and alcohol use among African American young women: the mediating role of emotion dysregulation
AbstractHitch, A. E., Brown, J. L., & DiClemente, R. J. (n.d.).Publication year
2023Journal title
Journal of Ethnicity in Substance AbuseVolume
22Issue
2Page(s)
433-452AbstractAfrican American women experience a high prevalence of alcohol-related consequences, and no studies have explicitly examined the associations among lifetime interpersonal abuse, emotion dysregulation, and alcohol-related outcomes during the critical period of young adulthood within this population. This study used baseline data from a sample of African American young women (N = 560) who use alcohol, aged 18 to 24, enrolled in an HIV prevention intervention trial to examine whether emotion dysregulation mediated the relation between lifetime history of abuse and problematic alcohol use. Further, we sought to examine whether there were potential differential levels of problematic alcohol use based on the number of abuse types experienced. Multiple regression analyses showed that exposure to two or more forms of abuse was associated with problematic alcohol use, β =.24, p <.001, and heavy alcohol consumption, β =.23, p <.001, whereas history of a single form was not. Indirect effects of both single and multiple forms of abuse on problematic alcohol use (95% confidence interval [CI] [.16, 1.02]; [.46, 1.64]) and heavy alcohol consumption (95% CI [.02,.26]; [.05,.45]) via emotion dysregulation severity were found. Abuse and emotion dysregulation were associated with frequency of alcohol use and binge drinking, but not typical amount consumed. Hazardous alcohol consumption was prevalent among this sample of African American young women who use alcohol. This study provides preliminary evidence that emotion dysregulation may be an important mechanism buttressing the association between lifetime history of interpersonal abuse and problematic alcohol use among African American young women who use alcohol.Perceptions of Sexual Risk and HIV/STI Prevention Among Black Adolescent Girls in a Detention Center: an Investigation of the Role of Parents and Peers
AbstractQuinn, C. R., Boyd, D. T., Beaujolais, B., Hughley, A., Mitchell, M., Allen, J. L., DiClemente, R. J., & Voisin, D. (n.d.).Publication year
2023Journal title
Journal of Racial and Ethnic Health DisparitiesVolume
10Issue
3Page(s)
1224-1233AbstractBlack American adolescent girls constitute approximately one third of the US youth legal system population. Their overrepresentation in the youth punishment system is an indicator of significant physical, sexual, and/or behavioral health needs. Since less is known about perceptions of HIV/STI risk among Black girls with juvenile justice histories, we used intersectionality theory to explore the following: (1) how a sample of Black girls in detention endorse their perceptions of sexual safety given the multiple intersections of their race, gender, and SES and (2) how their endorsements align with interlocking systems of social inequality for system-involved Black at the social structural level. We examined relational and behavioral factors associated perceived HIV/STI risk. Among a sample of 188 Black girls (ages 13–17 years), we examined parent and partner sexual communication, fear of condom negotiation, a positive STI test, and partner risk profile as significant correlates. Major findings indicated that greater partner communication was associated with higher perceived HIV/STI risk, whereas having had a risky sexual partner, fear of condom negotiation, and having had a positive STI test were correlated with lower perceived risk. The significant factors identified in this study can be the focus of STI prevention and intervention programs for Black girls with youth punishment histories.Social Media Utilization Within Asian American Families and Its Role in Healthy Lifestyle Behavioral Influence: Results From a Nationwide Survey
AbstractMohsin, F. M., Ali, S. H., Chong, S. K., Parikh, R. S., DiClemente, R. J., & Hu, L. (n.d.).Publication year
2023Journal title
Social Media and SocietyVolume
9Issue
3AbstractObjective: Social media platforms are effective tools for promoting public health and implementing impactful health interventions. This study explored social media utilization patterns among young Asian American adults and their effect on perceived family influence on lifestyle behaviors. Methods: The study analyzes data from Asian American young adults (aged 18–35 years) participating in an online survey in March 2021. Results: A total of 739 Asian Americans participated in the survey: 45.6% East Asian, 23.4% Southeast Asian, and 22.7% South Asian. Common social media platforms include Facebook Messenger (60.9%) and Instagram (57.0%). US-born Asian Americans reported higher odds of using Instagram (adjusted odds ratio [AOR]: 1.64, 95% CI: [1.09, 2.46]) than foreign-born Asian Americans. Higher acculturation was associated with lower odds of using Instagram among South Asians (AOR:.46, 95% CI: [.24,.83]) and greater odds of using Instagram among East Asians (AOR: 1.72, 95% CI: [1.09, 2.75]). Interacting with mothers using Facebook and Instagram had a higher perceived influence on one’s ability to improve sleep (AOR: 2.08, 95% CI: [1.19, 3.65]; AOR: 2.53, 95% CI: [1.15, 5.55]) and develop stress-management strategies (AOR: 1.73, 95% CI: [1.02, 2.96]; AOR: 4.05, 95% CI: [1.83, 9.49]). With one’s siblings, Facebook was associated with a lower perceived influence on avoiding risky substances (AOR:.48, 95% CI: [.23,.97]), and WhatsApp was associated with a higher perceived influence on one’s ability to develop stress-management strategies (AOR: 3.10, 95% CI: [1.26, 7.78]) and form/maintain relationships (AOR: 2.58, 95% CI: [1.02, 6.58]). No significant findings with father interactions were observed. Conclusion: Findings provide evidence for researchers seeking to tailor social media–based interpersonal health interventions to address the unique needs of diverse Asian American communities.